Provider Demographics
NPI:1881796183
Name:MIAN, MOHAMMAD AFZAL (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:AFZAL
Last Name:MIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3800
Mailing Address - Country:US
Mailing Address - Phone:502-817-0927
Mailing Address - Fax:502-805-0690
Practice Address - Street 1:8521 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40242-3800
Practice Address - Country:US
Practice Address - Phone:502-817-0927
Practice Address - Fax:502-805-0690
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22242174400000X
IN01037543A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100116470Medicaid
KY64222425Medicaid
KY64222425Medicaid
IN243300AMedicare PIN
KYD18369Medicare UPIN